A Brief Note On Femoral Access When Carrying Out Ppci
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This issue could further be addressed by using radial as opposed to femoral access when carrying out pPCI. A trial found that there was a reduced incidence of major bleeding and vascular site complication with a radial approach. Events occurring in 1.4% of those treated with radial approach and 7.2% P<0.0001 of those with femoral access with a reduction in the rate of net adverse clinical events (NACE) defined as “a composite of death, myocardial infarction, stroke, and major bleeding/vascular complications” with 4.6% vs. 11% P=0.0028. Finally there was reduced rate of mortality, without statistical significance of 2.3% vs. 3.1% at 30 days and 2.3% vs. 3.6% at a 6 month follow up (15).
The trial concluded that when practitioners were well…show more content… £6,802; p=0.653 and £8442 vs. £7,731; p=0.213 respectively)”. And although initial costs of pPCI were higher, it resulted in a reduced average hospital stay of 4 days compared to that of 8.5 days with those receiving fibrinolysis. These findings were echoed by the National Infarct Angioplasty Project which concluded that pPCI was both feasible and cost effective, if delivered in a timely fashion (16, 17).
The importance of time
A further study of the DANAMI-2 trial focusing on timing of intervention in STEMI (18) attempted to determine the importance of system delays in treatment of patients with fibrinolysis or pPCI. It found that the effectiveness of pPCI was less sensitive to time than that of fibrinolysis, although they both showed incremented increase in absolute mortality associated with delay. Their findings are present in figure 5:
These findings suggest that if pPCI is performed within 1-2 hours, it offers the best reduction in absolute mortality when compared to fibrinolysis both at 30 days with statistical significance 2.6% vs. 6.9% P=0.04, and at 8 years with a trend, 21.8% vs. 29.4% P=0.07. However when pPCI was delayed by more than 3 hours it showed mortality rate similar to that of fibrinolysis given between 1-2 hours at both 30 days and 8 years(18).
This data suggests that to gain the best results from pPCI it is best to begin treatment within 120 minutes, as set out by the NICE